Saunders · High altitude medicine & biology 2009 · narrative review · n=?

Endurance training at altitude.

Cited 132 times in the scientific literature.

Level 5 - mechanism / opinion, no new human data

Narrative review of physiological mechanisms and training recommendations without systematic review methodology.

PubMed 19519223 · doi:10.1089/ham.2008.1092 · record verified 2026-08-31

What was done

This narrative review synthesized physiological responses, acclimatization timelines, and training design considerations for endurance athletes training at moderate altitude (approximately 2000 to 3000 m) to enhance performance at altitude and sea level.

What was found

Acute exposure to moderate altitude decreases maximal aerobic power (VO2max) by approximately 15% to 20%, accompanied by increased ventilation, increased heart rate, decreased stroke volume, and reduced plasma volume. Chronic acclimatization requires exposure to altitudes greater than approximately 2000 m for more than 3 weeks and adequate iron stores to elicit increases in red blood cell volume and VO2max. Elite Ethiopian runners (living at 2000 to 3000 m) demonstrate only marginally elevated hemoglobin concentrations. Training recommendations include short-duration (approximately 1 to 2 min) high-intensity efforts with long recoveries, targeting performance gains where the smallest worthwhile change is as little as 0.5%.

Why it matters

It outlines specific threshold conditions (minimum 3 weeks at >2000 m with adequate iron stores) required for hematological adaptations and provides a physiological rationale for incorporating short, high-intensity intervals to preserve race-specific fitness at altitude.

Limits

The abstract describes a narrative review without systematic search parameters, quantitative meta-analysis, or pooled sample sizes. It presents general physiological mechanisms rather than controlled trial data comparing specific altitude training regimens.

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